Stigmatized people are seen as different, and in that difference, wrong.
“Kindness in ourselves is the honey that blunts the sting of unkindness in another”
– Walter Savage Landor
In days gone by, mental illness was widely seen as weakness. Those afflicted needed to ‘think straight’ or ‘buck their ideas up’ and ‘get a backbone!’
I’m certainly not negating resilient stoicism, but we need balance in all things. No one chooses mental illness.
Stigma is a combination of two elements. First, the stigmatized person is seen as fundamentally different from you or me. This can lead to all kinds of behaviours, from avoidance of the stigmatized person to active belittling and discrimination of them. Second, they are seen to be at fault in some way. So they are seen as different, and in that difference, wrong.
The fact that we even discuss ‘stigma’ now shows how, to some extent, things have progressed.
And yet as my client John sat before me, his self-stigma seemed to be tying him up in self-loathing.
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Being your own detractor
Self-stigma happens when people absorb public attitudes about themselves and collude with those attitudes to ‘victimize’ themselves. For example, a boy who internalizes the propaganda that ‘all men are weak’ may grow up feeling he himself is weak simply because he is a man.
John told me how usually he was “sensible and normal”. He felt “stupid” for having been signed off work with depression. He wondered what his co-workers were saying about him, and couldn’t shake the memory of one, Bill, having once talked about someone he knew as having “gone full loony” after a divorce.
But do people suffering a mental health crisis really still suffer stigma, even now?
Peace, love, and understanding?
On the face of it, we seem to be living in an era of openness around mental health. Celebrities share their stories of anxiety, addiction, and depression. People generally understand when someone is off work ‘with stress’. People often talk about their struggles more openly.
We seem to have shaken off many of the shackles of mental health. And yet…
Something may be changing for the worse.
A recent tide of rising stigma
Compared to fifty years ago, there does seem to be more acceptance and understanding of mental illness now.1 But sadly, the trend of mental illness acceptance may be starting to reverse.
A recent survey highlighted a troubling rise in some measures of stigma around mental illness, marking the first increase in a decade.2
Findings from over 1,600 participants in England reveal a shift in attitudes, with fewer people believing in full recovery for those with mental health issues. Just 59% believed full recovery is possible in 2023, a drop from 67% in 2019.
This suggests to me that people are seeing mental illness less as a human situation that someone is ‘going through’ and more as some intractable difference in the one suffering compared with ‘normal’ people.
Another concerning outcome was that only 55% said they would live with someone with mental illness, down from 66% in 2019. Professor Claire Henderson, a co-author of the study, suggests that the pandemic and economic struggles may have played a role in this change by limiting access to care and making recovery more challenging.
While some progress persists, like growing acceptance of people with depression marrying into families, increased willingness to interact with people with depression and schizophrenia, and improved attitudes to workplace discrimination, Dr. Sarah Hughes, CEO of mental health charity Mind, warns that overall, the increase in stigma is a red flag – a warning, that, unless we are careful, we as a culture could slide back into non-acceptance and -understanding of those going through mental and emotional suffering.
Stigma and acceptance are both predicated, of course, on the way mental health problems are viewed. So what way of viewing someone’s suffering leads to less stigma? The answer might surprise you.
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Sick, or going through a tough time?
Some people assume, I think, that stigma decreases if we use a disease or illness metaphor. And in a way, being depressed or highly anxious or manic or psychotic is like an illness. But the disease model of mental health can be taken too far and can actually, it seems, increase stigma.
In a piece of research from Auburn University, Alabama, subjects who believed their research partner in a simple learning task had a mental illness due to stuff that happened to them as a kid were much more understanding than those who believed their partner had a mental illness due to bad biochemistry.3,4
Subjects were more likely to be cruel and administer more severe electric shocks when their partner (who was really a planted confederate of the researchers) told them they had faulty brain chemistry.
So it seems that “it’s a disease like any other” doesn’t make for more understanding from other people. If we feel people are ‘wired differently’ to us or that their brain chemicals are all wrong, it may actually lead us to treat them worse.
So how might we help the stigmatized client?
Method one: Normalize and educate
I helped John to understand that mental health issues are common and usually highly treatable. He wasn’t stuck with a ‘disease’ but rather responding to a difficult period in his life.
“We can all get overwhelmed sometimes, and there’s no shame in that,” I told him. John was into cars, so I asked him what would happen if he ran his car indefinitely without ever putting oil in the engine or gas in his tank.
“Obviously it wouldn’t be able to go anywhere.”
“That’s right,” I said, “but that doesn’t mean the car is ‘weird’ or ‘crazy’ or even malfunctioning. It’s just behaving as it should when it isn’t getting what it needs.”
After that we explored John’s primal emotional needs, which he began to call his ‘fuel and oil’.
We also tackled his fear of stigma and ridicule and contempt. I suggested that, sure, he’d heard one co-worker talk once about someone “going full loony”, but that didn’t mean other people took the same view. In fact many, perhaps most, people know someone who has been depressed or anxious or addicted.
I wondered aloud whether he might be surprised at how much more understanding and sympathetic people were than he had given them credit for. After all, his father had died recently, his wife had been very ill, and he’d had a rift with a sibling.
Normalizing helped John feel better able to understand why he had become depressed. But I wanted to build on that self-compassion.
Method two: Build self-compassion
I asked John to tell me how he would feel and what he would think if he heard that a co-worker he really liked (and it seemed John was really well liked by his co-workers) had become depressed and needed time out from work.
He told me that he’d be really concerned.
“Would you think they had gone ‘full loony’ or that they were weak?”
“No, I would just think they must have reached a breaking point. It would be stupid to blame them when I’d just be worried for them!”
I asked him to say aloud to me what he might say to a person like that, and he did. He offered support and kind words of understanding.
Next I used hypnosis to do a self-compassion exercise. In his mind, I had him sit down in a chair opposite himself and remind himself of his strengths and resources.
I also taught him about all-or-nothing thinking, also known as ‘headline thinking’, and how to spot it in himself so that he could modify self-critical thoughts. He began to be kinder to himself.
We can remind our clients that having a mental illness doesn’t diminish their worth or even, necessarily, their potential. Building self-compassion helps them resist internalizing negative stereotypes.
But we can also explore with the stigmatized or self-stigmatized client the issue of disclosure.
Method three: Encourage selective disclosure
I talked with John about how he felt about letting people in his life know he’d been going through depression. We can empower our clients to take control of when and to whom they reveal their diagnosis.
We discussed the pros and cons of disclosure in different situations and with various people. This can reduce the feeling of vulnerability by allowing clients to choose environments where they’re likely to be met with understanding and support.
This was a welcome concept for John, who had almost been assuming he’d have to tell everyone he knew or even met.
Method four: Challenge and reframe beliefs
In our work together John and I also set about identifying some of his assumptions and core beliefs around mental illness, and depression in particular. Using Socratic questions, metaphor, and even humour, I was able to help John reframe some of the more depressing and hopeless beliefs he had around the state of depression.
We used cognitive behavioural techniques to examine thoughts about stigma, such as “People will think I’m weak”, which is something John had actually said. I gently suggested that “seeking help shows strength.”
So reframing can help reduce the impact of societal stigma on self-image.
But every man, woman, and child exists within a framework of other people – so I wanted to know that John was reaching out to and being with people who were good for him.
Method five: Foster connections with supportive communities
John had become a little isolated, and although he lived with his wife they spent a lot of time apart in the same house.
Not only did we explore ways to strengthen that relationship, but we looked at how we could reconnect John to good people who didn’t judge.
We all need a sense of belonging, and it seemed that since being off work with depression John was feeling the lack of belonging sharply. John started attending his local football club again, and bit by bit engaged more with people and life around him again. To his surprise, he found that no one was laughing at him or judging him badly.
For some self-stigmatizing clients, interacting with others facing similar challenges helps them feel validated and understood, providing an alternative to the judgement they might encounter elsewhere. In these cases, you can encourage them to join support groups or engage with mental health communities, either online or locally.
And finally, we can help our clients understand that a diagnosis isn’t an identity.
Method six: Focus on strengths and identity beyond the illness
A diagnosis can come to feel like a label which, once stuck, can’t be removed and will forever determine who and what we are. As long as we see our diagnosis in this way, we limit ourselves.
John never actually said “I’m a depressive”, but some clients will describe themselves through a label – so we can help them transcend that.
We want our clients to feel like whole people, not defined or confined by their diagnosis. As part of this approach we can guide our clients to explore their strengths, interests, and values.
Remind them that their illness is just one part of who they are. This broader self-concept helps counteract the stigmatized “label” by anchoring self-worth to their unique qualities.
These approaches all aim to empower clients, helping them build resilience and self-acceptance so they can move forward confidently, regardless of societal judgement (whether real or imagined).
After one of our sessions, John said, “Thank God I don’t have to feel depressed about feeling depressed.” I knew what he meant.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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Notes:
- Although there still seems to be less understanding of, and more stigma attached to, psychotic illness: Yang, L. H., Anglin, D. M., Wonpat-Borja, A. J., Opler, M. G., Greenspoon, M., & Corcoran, C. M. (2013). Public stigma associated with psychosis risk syndrome in a college population: Implications for peer intervention. Psychiatric Services, 64(3):284-288.
- Ronaldson, A. & Henderson, C. (2024). Investigating changes in mental illness stigma and discrimination after the Time to Change programme in England. BJPsych Open, 10(6):e199.
- Mind (2024, October 9). Warning lights flashing on mental health stigma, says Mind.
- Mehta, S. & Farina, A. (1997). Is being “sick” really better? Effect of the disease view of mental disorder on stigma. Journal of Social and Clinical Psychology, 16(4): 405-419.
